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COVID 19 and diabetes: a lethal partnership? How do we overcome this?

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By Dr. Kayathri Periasamy

With the latest wave of COVID-19 infections sweeping steadily across Sri Lanka, attention has been directed towards persons with uncontrolled, pre-existing conditions, particularly diabetes; as a sect most vulnerable to get severely ill or die because of complications caused by the virus. This has shed light on another growing concern among healthcare providers and patients, which is that patients suffering from diabetes or other chronic conditions are finding it increasingly difficult or are unable to access the medical care they require due to mandatory albeit essential curfew measures combined with a deep fear of contracting the virus in communal healthcare settings.

With a staggering 463 million adult diabetic patients present worldwide, World Diabetes Day 2020 – falling on the 14th of November- is a critical time for diabetes support communities and healthcare advocates to rally together to create awareness about this debilitating medical condition and push for progress in the standards of care and the better management of diabetic patients during a pandemic. In Sri Lanka alone, 1 in 10 adults are approximated to suffer from the disease. It is also then vital to look at ways to help stop more people from getting this disease, particularly at a time when ‘lockdown’ lifestyles are more often than not likely to be sedentary, unhealthy and stressful; an ideal background for a diabetes diagnosis.

Why is uncontrolled diabetes such a potent accelerant for COVID-19?

A recent study conducted by Lancet on Diabetes & Endocrinology screened over 61 million medical records in the U.K. to find that 30% of COVID-19 deaths can be attributed to people with diabetes. After accounting for factors such as demography and chronic medical conditions, the risk of succumbing to the virus was shown to be about three times higher for people with Type 1 diabetes and almost twice as high for Type 2, versus those without the disease. 

There appears to be two primary reasons driving this predicament. Over a lifetime, poor glucose control inflicts widespread damage in our systems which can lead to strokes, heart attacks, kidney failure, eye disease, and limb amputations. The linings of blood vessels throughout the body weaken to an extent where they can’t ferry necessary nutrients adequately. Inflammation is another byproduct of poor diabetes control, which makes the body ill-prepared for the onslaught of the viral disease. Secondly, the rich environment of elevated blood glucose present in diabetic patients, makes them prone to superadded bacterial complications during the viral infection. Many diabetics also tend to have other co-morbidities such as obesity, hypertension, and heart disease, which are all factors that aggravate complications during viral illneses. These problems are seen in any infections in the setting of diabetes and not only with COVID 19. The pandemic has just highlighted the difficulties of having diabetes

 

What precautions can diabetic patients take?

So during this pandemic, apart from strict adherence to general COVID-19 personal safety protocols such as strict social distancing and sanitization, it is important for patients to regularly monitor their glucose levels to avoid complications caused by fluctuating blood glucose. Proper hydration is essential for good health. It is also crucial to have access to a good supply of the prescribed diabetes medications and healthy food so that patients are able to correct the situation if blood glucose levels fluctuate. Finally, sticking to a comfortable daily routine, maintaining an exercise program even within the confines of your home, reducing excessive work and having a good night’s sleep can go a long way in keeping you strong. In essence, maintaining good blood sugar levels may be their best defense against severe COVID-19.

Disruption to continuity of care for diabetes patients

A rapid assessment survey conducted by WHO among Ministries of Health across many countries, focusing on the service delivery for NCDs during the COVID-19 pandemic, revealed deepening concerns that many people living with NCDs are no longer receiving appropriate treatment or access to medicines during the COVID-19 pandemic. The more severe the transmission phase of the COVID-19 pandemic, the more NCD care services were disrupted.

With our country currently in the cluster transmission phase and heading towards the community transmission phase due to the large and distant spread of the first-line contacts, the threat to NCD care and especially routine and emergency care of diabetes patients worries us physicians. As healthcare providers, we too are torn between the dilemma of not wanting to expose our patients to unnecessary hospital visits and the need to ensure that all our patients have continued access to their healthcare team along with a steady supply of medicines and other diabetes care products such as glucometer strips and insulin. Unfortunately, the delay in visiting their healthcare provider when they have symptoms of complications has caused many people to present late to the hospital with heart attacks or infections. A delayed presentation, weakens the patient further.

This disruption to healthcare services is foreseen to be a huge dilemma for patients and healthcare providers alike, especially when it comes to the care of patients with diabetes and other non-communicable diseases. In Sri Lanka, the Ministry of Health, is currently providing a number of telemedicine services and has opened avenues to deliver medicines to houses without diabetic persons having to visit crowded settings

 

How do we counter this?

At Healthy Life Clinic, we adhere strictly to COVID-19 safety operational health protocols established according to Ministry of Health (MOH), Epidemiology Unit. All incoming patients are screened by our nurses as soon as appointments are made over the phone, to understand the nature of their illness. If there is a worry that they could have contracted COVID-19 or have been in contact with such patients, they are given the opportunity to speak to the doctor first over the phone for a detailed history. Every patient will be consulted and no one is turned away from our care.

In order to help patients overcome barriers such as curfews or even the fear of entering communal healthcare settings, our experienced, highly-regarded team of consultants conducts telehealth consultations via established, trusted telemedicine partners such as oDoc and Mydoctor.lk to maintain continuity of care throughout this pandemic. We have also moved many of our long-standing diabetes care and weight management programs online, which have proven to be effective even in the absence of a physical meeting and examination. Additionally, our social media platforms and website are constantly updated to increase awareness about this condition, along with content that informs people about the proper management and prevention of diabetes – particularly when it is thus connected to COVID-19.

 

(Dr. Kayathri Periasamy is a consultant physician MBBS (UK), MRCP (UK), Board Certified in Int. Medicine (U.S.A). She is the founder of Healthy Life Clinic, Colombo 07.)



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Salon owners contemplating pulling the plug, putting more than 300,000 jobs at risk

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  • = Ban on imported cosmetic products hampers industry
  • = Marked decrease in consumers patronising salons
  • = Developing Sri Lanka as a wedding-hub ‘fading away’
  • = Urges President to help protect the self-reliant industry

By Sanath Nanayakkare

Ninety percent of salons across Sri Lanka are at the risk of closure unless the temporary ban on imported cosmetic products is lifted soon, Jackie Aponso, president, Hair and Beauty Cluster (HBC) said last week addressing a press conference in Colombo.

She claimed that such an eventuality could lead to 75%-80% job losses of industry personnel. “That’s a large number as HBC is a unification of many associations in the beauty and personal care sector with 450,000 members,” she said.According to the figures given by her if the situation persists, 337,500 – 360,000 jobs would be lost for employees in the industry.

‘Yes, there is a sound fiscal argument for the government’s temporary ban on imported cosmetic products in the tight foreign exchange reserves backdrop. But if the ban is not lifted by the end of this month to facilitate the availability of international cosmetic brands in the market for upcoming Christmas and New Year, its impact will take a devastating toll on the 450,000 self-employed individuals engaged in the industry and 1.5 million of their dependents”, Jackie said.

‘Most foreign and local customers prefer international brands for their hair and skin treatments. Although a number of home-grown cosmetic brands have emerged, customers prefer their hair and facials done with brands that have been frontrunners in the market which they have relied on for years. Being a highly customer-centric business, we have to work with formulas that customers are comfortable with, because they are concerned about what we put on their face and hair.”

“It’s a relief to hear that the import ban is temporary. But it needs to be lifted quickly to allow sufficient lead time for cosmetics importers to place orders and bring the products to Sri Lanka. It was no secret that our industry was heavily battered by the Covid-19 pandemic and somehow we braved up to this point safeguarding our businesses. And we all have been looking forward to this season to offset the losses we suffered in the past two and a half years. If the ban is lifted by end of this month, imported brands will be available in the market by mid or end of November, and salons will be well-positioned to start work diligently as the season kicks off. But if the imported products reach here as late as mid-December, then this year also will be marked as another unfortunate business year for the salon industry, “she said.

“When we don’t have wedding makeup essentials, a number of other industries also will get affected; such as hotels, wedding and event planners, wedding florists, bridal photographers, Poruwa suppliers, hall decorators and so on. As a result of the import ban, a black market has emerged where the prices of cosmetics have gone up by 6-7 folds. This has put 90% of our beauty and personal care parlours in great difficulty. A hair spray which was about Rs. 2,000, now costs Rs. 12,000. Can we pass that cost burden to the customer? No, we can’t. It is the same with all other products. There are a few salons that can afford such high costs and charge high prices, but the majority of our members are not so, and they are at the risk of closing their businesses. As there has been a marked decrease in customers patronizing salons, some members even called us and asked for help to sell their equipment and exit the industry. Such a situation may create an unemployment problem as they are all self-employed individuals.”

According to HBC, the industry’s cosmetics import bill accounts for 0.08% of the total national import bill. They also highlighted the fact that all registered cosmetics importers and HBC members pay their due taxes to the government.

Salon entrepreneur Bernie Balasuriya said: “Our industry brings in foreign exchange to the country. When foreigners and expatriates come to Sri Lanka for weddings, their families stay in hotels for about a week. Sometimes we set up salon space inside the hotel to cater to beauty and personal care needs of these visitors. They want us to use international cosmetic brands. This is an industry which earns foreign exchange and which therefore demands best industry practices.”

Theekshani Kariyawasam, Gold medal winner at OMC Hairworld in France in the category of bridal makeup, who successfully competed against contestants from more than 60 countries, said that the situation is so sad especially because Sri Lankan beauty artistes and entrepreneurs have never been a burden on the economy. We have always relied on our own talent and commitment. We need international cosmetic products to work with and be recognized for highest standards on par with other destinations.”

Asoka Thilakaratna who boasts 35-years of experience in the industry said,”Skilled Sri Lankan hairdressers and beauticians get overseas jobs because they have a lot of knowledge and experience in working with international cosmetic brands and techniques. That serves as a plus point for them at job interviews with prospective foreign employers. Further, I heard the good news that there would be some Indian weddings taking place here in Sri Lanka in November, December and January. I know from my experience that they come as groups about a week before the wedding and get all their beauty treatments done in Sri Lanka. If we don’t have cosmetic brands they love and trust, we could miss out on these business opportunities because they make it a point to stay away from lesser known products and fake products.”

Concluding the comments, Jackie Aponso said,” We have made an appeal to President Ranil Wickremasinghe to consider the lifting of the ban with the objective of protecting this self-reliant industry and its self-employments. We look forward to a favourable solution in time to get back to business.”

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Sri Lanka eyes $2.9 billion IMF loan finalised in December 2022

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Sri Lanka expects the International Monetary Fund (IMF) Board to approve a $2.9 billion loan by year-end, according to a news report by Reuters.The IMF Board approval of the loan is expected by mid-December. From now until mid-November, the country aims to get financing assurances from public- and private-sector creditors.

The country earlier this month reached a staff-level agreement with the IMF for the loan of about $2.9 billion, contingent on it receiving financing assurances from official creditors and negotiations with private creditors.

“It’s going be very tough, but so much of it depends on China, basically one creditor, so maybe it can be done,” a bondholder told Reuters on condition of anonymity.

The virtual presentation to investors on Friday marks the first time the Sri Lankan government has formally engaged with private bondholders after deciding earlier this year that it would restructure $13 billion in international sovereign bonds, held by private creditors such as asset managers BlackRock and Ashmore.Central Bank Governor Nandalal Weerasinghe and Treasury Secretary Mahinda Siriwardena participated in the virtual presentation on Friday, along with representatives of financial and legal advisers Lazard and Clifford Chance.

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SLIM launches SLIM DIGIS for 4th consecutive year

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Sri Lanka Institute of Marketing (SLIM), the apex body for Sri Lankan Marketers, has opened entries for the 2022 edition of SLIM DIGIS from the 23rd of September until the 25th of October 2022. SLIM DIGIS celebrates and rewards outstanding work and talent within the digital sphere. This year’s competition, SLIM DIGIS 2.2, features two awards categories; the special awards category and the main awards category, under which multiple awards are poised to recognize the Best Digital Marketing campaigns from a range of categories chosen specifically to reflect the development and growth of Sri Lanka’s digital marketing sector.

Nuwan Gamage, President of SLIM, stated, “During the last 3 years, as a nation, we have faced numerous challenges than we have ever faced in our history. Consumer behavior changed dramatically, and companies that acted quickly were able to thrive despite the changing economic backdrop. In those agile approaches, we have seen digital marketing play a vital role and I firmly believe that it will continue to play a very prominent role in the nation’s branding national initiative that we are running currently to position Sri Lanka globally to travel, invest and live. I would like to invite all the digital marketers and brand owners to showcase great digital execution that they have done in this challenging environment.”

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